菖蒲郁金汤加减对HBV相关慢加急性肝衰竭肝功能、炎症因子及血清内毒素的影响

Effect of Modified Changpu Yujin Decoction on Liver Function,Inflammatory Factors and Serum Endotoxin in Patients with HBV-related Acute-on-chronic Liver Failure

目的评价菖蒲郁金汤加减治疗HBV相关慢加急性肝衰竭(HBV-ACLF)毒热蕴结证的临床疗效及对炎症因子及血清内毒素(ET)的影响。方法将64例HBV-ACLF患者随机分为对照组和观察组各32例。对照组给予西医综合治疗措施;观察组在对照组治疗的基础上口服菖蒲郁金汤加减方。疗程为4周。检测治疗前后血清总胆红素(TBil)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、白蛋白(Alb)、凝血酶原活动度(PTA)、纤维蛋白原(FIB)、凝血酶原时间(PT)和血小板计数(PLT)等肝功能和凝血功能指标;比较治疗前后慢性肝衰竭联盟-慢加急性肝衰竭预后(CLIF-CACLF)评分和毒热蕴结证评分;检测治疗前后白细胞介素-2(IL-2)、白细胞介素-17(IL-17)、干扰素-γ(IFN-γ)、肿瘤坏死因子-α(TNF-α)和ET水平。结果治疗后,两组TBil、ALT、AST、PT、INR水平下降,Alb、PTA、FIB和PLT水平升高(P<0.05),且治疗后观察组TBil、ALT、AST、PT、INR低于对照组(P<0.05),Alb、PTA、FIB和PLT水平高于对照组(P<0.05);治疗后,两组CLIF-CACLF评分和ET水平下降(P<0.05),且观察组低于对照组(P<0.05);治疗后,两组IL-2、IL-17、IFN-γ和TNF-α水平下降(P<0.05),且观察组低于对照组(P<0.05);治疗后,两组主要症状评分和总积分均下降(P<0.05),且观察组低于对照组(P<0.05);治疗后,观察组临床疗效总有效率为90.62%,高于对照组的68.75%(P<0.05)。结论菖蒲郁金汤加减内服治疗HBV-ACLF毒热蕴结证患者,可抑制炎症因子和内毒素血症,减轻损伤程度,促进肝功能恢复,改善凝血功能障碍,减轻临床症状,临床疗效优于单纯西医治疗,值得进一步研究与使用。

Objective:To evaluate the clinical efficacy of Modified Changpu Yujin Decoction in the treatment of HBV-related acute-on-chronic liver failure(HBV-ACLF)with toxic heat accumulation syndrome and its influence on inflammatory factors and serum endotoxin(ET).Methods:A total of 64 patients with HBV-ACLF were randomly divided into control group(n=32)and observation group(n=32).In the control group,comprehensive western medicine treatment measures were given;in the observation group,Modified Changpu Yujin Decoction was orally administered on the basis of treatment in the control group.The course was 4 weeks.Serum total bilirubin(TBil),alanine aminotransferase(ALT),aspartate aminotransferase(AST),albumin(Alb),prothrombin activity(PTA),fibrinogen(FIB),prothrombin time(PT),international normalized ratio(INR)and platelet count(PLT)were measured before and after treatment;chronic liver failure alliance-chronic plus acute liver failure prognosis(CLIF-CACLF)score and toxic heat accumulation syndrome score were compared before and after treatment;interleukin(IL)-2,IL-17,interferon(IFN)-γ,tumor necrosis factor-α(TNF-α)and ET levels were measured before and after treatment.Results:After treatment,the TBil,ALT,AST,PT and INR levels decreased,Alb,PTA,FIB and PLT levels increased in the two groups(P<0.05),and after treatment,TBil,ALT,AST,PT and INR in the observation group were lower than those in the control group(P<0.05),Alb,PTA,FIB and PLT levels were higher than those in the control group(P<0.05);CLIF-CACLF score and ET levels decreased(P<0.05)in the two groups after treatment,and IL-2,IL-17,IFN-γand TNF-αlevels decreased(P<0.05)in the two groups after treatment,and they were lower in the observation group than in the control group after treatment(P<0.05);major symptom score and total score decreased(P<0.05),and after treatment,the observation group was lower than those in the control group(P<0.05);after treatment,the total effective rate of clinical efficacy was 90.62%in the observation group and 68.75%in the control group,and the observation group was higher than the control group(P<0.05).Conclusion:Modified Changpu Yujin Decoction can inhibit inflammatory factors and endotoxemia,reduce the degree of injury,promote the recovery of liver function,improve coagulopathy and reduce clinical symptoms in patients with HBV-ACLF toxic heat accumulation syndrome.The clinical efficacy is superior to western medicine alone,which is worthy of further study and use.